Health response to the earthquake in Haiti, January 2010

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THE HEALTH IMPACT - Chapter 3salaries paid by the Government. Relatively few physicians were present in the healthfacilities at the time of the impact. For instance, in the main tertiary level facility, theUniversity Hospital, only the night shift was present.In addition, the Ministry of Health survey found that 245 (2.2%) of Ministry stafflost a member of their immediate family (spouse or children) and 3,955 (67%) weretechnically homeless (30% of their houses were destroyed and 37% were damagedand potentially unsecure). The fact that many Ministry staff were reported absent forsome time is largely attributed to the fact that they had to find relatives and organizefor their survival before reporting to their duty stations.It was estimated that 50% of the health workers were living under tents for a sustainedperiod of time.Impact on population displacement• Reasonable estimates on size and place of displacements are essential for planningthe delivery of health, water, and sanitation services.• Statistics on displacement tend to be on the high side initially and are contestedlater.• The health effects of displacement are not limited to areas physically affected bythe earthquake.The level of destruction and loss of employment and homes led many people to seekshelter in temporary settlements. The concentration of displaced families in thousandsof small camps and settlements presented a health risk in itself and a challenge for theprovision of health services because it caused a massive redistribution of catchment areas.The situation was quite distinct from that observed in other countries where spaceallowed for organized, medium-scale settlements (10,000 persons or more). There wasno vacant land in Port-au-Prince itself and all small public spaces were overcrowded, initiallyleaving only 2 or 3 square meters per person. Common facilities (water, electricity,waste disposal) were non-existent and would compete for space.Monitoring the constant flux of displaced households under the conditions in Haitiwas particularly prone to inaccuracy. The number of camps was close to 1,200, somehousing only a few hundred persons. Families (or some of their members) shiftedfrom place to place according to the benefits (aid) to be expected. A detailed descriptionof the registration strategy used by the Camp Coordination and Camp Management“Cluster” was circulated by the International Organization for Migration(IOM) in April 2010.An official number of internally displaced after the earthquake (1.5 million in temporarycamps) was released by IOM and accepted initially by all partners, only tobe questioned one year later by scientists (and mass media). Discrepancies betweensources as well as internal inconsistencies in the figures are illustrated in Table 3.9.33
Health response to the earthquake in Haiti January 2010Table 3.9 Numbers of persons living in temporary sheltersin Haiti after earthquake, by sourceSourcePDNA (March 2010)IOM Registration Strategy (April2010)IOM Press Briefing Note (Dec 2010)USAID survey (Schwartz et al. 2011)Data1.5 M persons directly affectedAround 1.3 M living in temporary shelters in the metropolitanPort-au-Prince area; 500,000 moved into the restof the country450,000 households living in shelters a (i.e., at least 2 Mpersons)Peak figure in the camps was 1.5 MEstimated number of people who went to camps inJanuary is 866,412 to 894,588 ( p < .01)By April 2010, approximately half of those who had goneto camps or the countryside had returned homea According to the IOM, household size is estimated between 5.2 and 5.7 persons.The lesson is that any statistic, not only mortality data, can only be a rough estimatelikely to be subject to questioning. The key again is to resist the temptation to errsystematically to the higher side and to share the methodology adopted as was donein this case. There is no real benefit for the affected population to adopt the higherend of all measurements. A middle road approach will more likely make divergencebetween experts a matter of scientific debate rather than a public crisis affecting thecredibility of an agency.Faced with the situation in Port-au-Prince, the Government encouraged migration to nonaffecteddepartments, and buses were rapidly made ready to transport people. Since roadsin the affected area were impassable, buses were located at the periphery. Movements ofpeople away from the capital started spontaneously, during the night of 12 January; thefirst arrivals of the injured were reported in the early morning of 13 January at Saint Marsand Gonaïves hospitals. The flow of “evacuated injured people” continued for a few days,rapidly overstretching the response capacities of these facilities. Health services in the receivingareas, which were already insufficient to meet the most basic needs of the localpopulation, had to attend to a flux of reportedly between 500,000 and 600,000 disasteraffectedindividuals, many with injuries and emergency treatment needs. These healthfacilities normally charged for services, habitually saw only a few patients daily, and had nostocks of supplies to serve the increase in patients. How long the extra medical burden onnon-affected departments lasted is unclear.If efforts were made by the Government to encourage and monitor the initial movementout of Port-au-Prince, few data were sought by or provided to the humanitariancommunity on the return of those displaced.The Rapid Initial Needs Assessment for Haiti (RINAH) is one of the few studies thatexplored this issue in some depth. 29 Another survey commissioned by UNFPA confirmsthat more than a quarter of the population of the metropolitan area left after the12 January earthquake (Haiti Data Services 2010). Half migrated into urban areas of29 See: Assessment Capacities (ACAPS), 2010, Rapid initial needs assessment for Haiti (RINAH).34
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Page 12 and 13: PrefaceThe 12 January 2010 earthqua
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Health response to the earthquake i
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BEYOND TRAUMA CARE - Chapter 6Befor
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32 32AHealth response to the earthq
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INFORMATION MANAGEMENT- Chapter 7he
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INFORMATION MANAGEMENT- Chapter 7
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Chapter8Coordination• The primary
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COORDINATION - Chapter 8In emergenc
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COORDINATION - Chapter 8nership wit
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COORDINATION - Chapter 8critical ma
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COORDINATION - Chapter 8Figure 8.1
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COORDINATION - Chapter 8has been ov
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Chapter9Key strategiclessonsnextfor
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KEY STRATEGIC LESSONS FOR THE NEXT
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BIBLIOGRAPHYBabcock, C., C. Baer, C
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BIBLIOGRAPHYGosselin R. A., G. Gial
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BIBLIOGRAPHYKaufmann, D., A. Kraay,
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BIBLIOGRAPHY———. 2010a. Edito
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BIBLIOGRAPHYUnited Nations Office f
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BIBLIOGRAPHYWorld Health Organizati
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LIST OF ACRONYMSLRRDLSSMINUSTAHMOHM
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Annex1Conditionsin Haiti priorto th
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HAITI PRIOR TO THE EARTHQUAKE - Ann
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Annex2Chronologyof eventsfollowing
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CHRONOLOGY OF EVENTS FOLLOWING THE
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The 12 January 2010 earthquake was
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Health response to the earthquake in Haiti, January 2010

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